| NPI | 1528262045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 060246) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 308585-1204) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2021-11-15 |